## Facts

- Katherine Macaulay suffered from serious back problems and consulted Dr. Peter P. Anas, an orthopedic surgeon.
- Dr. Anas recommended spinal fusion surgery, which Macaulay agreed to undergo.
- After the surgery, Macaulay’s condition did not improve as hoped.
- Macaulay sued Dr. Anas for negligence in the United States District Court for the District of Massachusetts.
- At trial, Macaulay called another physician, Dr. Todd Albert, who had treated her after the surgery.
- On direct examination, Dr. Albert testified that screws placed during Macaulay’s surgery were misplaced in her spine.
- On cross-examination, Dr. Anas’s counsel questioned Dr. Albert about the medical standard of care and whether screw misplacement necessarily meant the surgeon violated that standard.
- Dr. Albert testified that misplacement did not necessarily mean Dr. Anas breached the standard of care.
- Macaulay objected that this standard-of-care questioning exceeded the scope of direct examination, but the district court overruled the objection.
- The jury returned a verdict for Dr. Anas, and Macaulay appealed.

## Issues

1. Did the district court commit reversible error by allowing cross-examination of Macaulay’s treating physician about whether misplaced screws necessarily constituted a breach of the standard of care, where direct examination focused on screw placement?

## Decision

- The First Circuit affirmed the judgment for Dr. Anas.
- The court held that permitting the challenged cross-examination did not amount to reversible error because the questioning was within the trial court’s discretion to manage the scope and fairness of cross-examination.
- The court concluded that probing whether the facts described on direct (including screw placement) supported an inference of negligence was a permissible line of cross-examination and did not warrant a new trial.

## Legal Principles

- Trial courts have broad discretion to control the scope of cross-examination, including whether questions may extend beyond a narrow reading of direct examination.
- Cross-examination may test the meaning and implications of testimony elicited on direct, including whether observed outcomes or conditions support the conclusions the examining party seeks the jury to draw.
- Appellate courts generally review evidentiary and trial-management rulings for abuse of discretion and will not reverse absent a showing that the ruling likely affected the verdict.

## Conclusion

*Macaulay v. Anas* affirmed a defense verdict in a medical-negligence case, holding that the trial court acted within its discretion by permitting cross-examination of the plaintiff’s treating physician on whether mispositioned screws necessarily showed a breach of the medical standard of care, even though the physician’s direct testimony focused on screw placement.


Macaulay v. Anas, 321 F.3d 45 (2003)